How to start a skilled nursing facility in South Dakota

South Dakota requires a Nursing facility license from South Dakota Department of Health, Office of Licensure and Certification to operate a skilled nursing facility.

License required

Yes

License

Nursing facility license

Issuing agency

South Dakota Department of Health, Office of Licensure and Certification

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

SDCL 34-12 (34-12-35.4 moratorium); ARSD 44:73

1. New beds or new facilities are allowed only within the statewide moratorium cap (enacted 1988, extended indefinitely in 2005 under SDCL 34-12-35.4); DOH may authorize additional beds or a new facility only if total statewide beds stay at or below the 2005 level
2. Apply to DOH for licensure and meet ARSD 44:73 sanitation, fire safety and construction rules
3. Pass licensure inspection; for Medicare/Medicaid complete federal certification and enroll with SD Medicaid

Program

South Dakota Medicaid (Department of Social Services, Division of Medical Services)

Enrollment portal

South Dakota Medicaid Provider Enrollment (PE) Portal

Application fee

SD Medicaid's enrollment page says no application fee is charged. (Federal rule 42 CFR 455.460 allows the fee; CMS set it at $750 for 2026.)

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The SD DSS enrollment page we could reach does not describe a separate state fingerprint process (its maintenance/revalidation page returned an error).

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. The SD DSS enrollment page we could reach does not describe a separate state site visit process.

Revalidation

Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. SD Medicaid ran a portal-wide revalidation when the PE Portal launched in 2021 (due June 7, 2021). Records that could not be revalidated were terminated, and existing providers did not have to re-sign provider agreements.

Full South Dakota Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

No

Agency

South Dakota Department of Health (nursing facility bed moratorium and redistribution)

Moratoria

A nursing facility bed moratorium dates to 1988 and was extended indefinitely in 2005 (SDCL 34-12-35.4). The Department of Health may let a facility add beds or approve a new nursing facility only by redistributing beds from closed facilities or voluntarily surrendered beds, so the statewide total cannot exceed the 2005 level. Redistribution runs through periodic requests for proposals (held most years from 2013 to 2025), and the department reports annually to the Legislature on the need for more beds (SB 6, 2017).

South Dakota certificate of need details →

State minimum wage

$11.85 an hour

Effective

2026-01-01

Scheduled increases

Adjusted each January 1 by CPI; the state publishes the new rate by October 15. The 2027 rate was not yet found.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Skilled nursing facilities — active organization NPIs (NPPES)

162 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

96 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

138,321 (as of Jun 1, 2026)

All South Dakota Skilled nursing Medicaid rates, ranked →